Celiac Disease on the Rise in Elderly

BALTIMORENew research from the University of Maryland School of Medicine Center for Celiac Research reveals celiac disease is increasing, especially among the elderly. According to the findings  that will be published in the December 2010, issue of the Annals of Medicine, the incidence of celiac disease in the United States has doubled every 15 years since 1974.

Celiac disease is triggered by consuming gluten, a protein found in wheat, barley and rye. Classic symptoms include diarrhea, intestinal bloating and stomach cramps. Left untreated, it can lead to the malabsorption of nutrients, damage to the small intestine and other medical complications.

Using blood samples from more than 3,500 adults, the researchers found that the number of people with blood markers for celiac disease increased steadily from one in 501 in 1974 to one in 219 in 1989. In 2003, a widely cited study conducted by the Center for Celiac Research placed the number of people with celiac disease in the United States at one in 133. As the people in the study aged, the incidence of celiac disease rose, echoing the findings of a 2008 Finnish study in Digestive and Liver Disease that found the prevalence of celiac disease in the elderly to be nearly two and a half times higher than the general population. The recent findings challenge the common speculation that the loss of gluten tolerance resulting in the disease usually develops in childhood.

"You're never too old to develop celiac disease," said Alessio Fasano, MD, director of both the University of Maryland's Mucosal Biology Research Center and Center for Celiac Research, which led the study.

The findings support the theory that people are not necessarily born with celiac disease, but can develop it quite late in life. Although researchers have identified specific genetic markers for the development of celiac disease, exactly how and why an individual loses tolerance to gluten remains a mystery.

"Even if you have these genetic markers, it's not your destiny to develop an autoimmune disease," Fasano said. "Our study shows that environmental factors cause an individual's immune system to lose tolerance to gluten, given the fact that genetics was not a factor in our study since we followed the same individuals over time."

The finding contradicts the common wisdom that nothing can be done to prevent autoimmune disease unless the triggers that cause autoimmunity are identified and removed. Gluten is one of the triggers for celiac disease. But if individuals can tolerate gluten for many decades before developing celiac disease, some environmental factor or factors other than gluten must be in play, notes Fasano.

Identifying and manipulating those factors could lead to novel treatment and possible prevention of celiac disease and other autoimmune disorders, including type 1 diabetes, rheumatoid arthritis and multiple sclerosis.